Department of Pharmaceutical Outcomes and Policy, University of Florida, College of Pharmacy, Gainesville, Florida, USA.
University of Florida, Health Science Center Libraries, Gainesville, Florida, USA.
Pharmacoepidemiol Drug Saf. 2024 Aug;33(8):e5861. doi: 10.1002/pds.5861.
Concomitant use of hormonal contraceptive agents (HCAs) and enzyme-inducting antiepileptic drugs (EIAEDs) may lead to contraceptive failure and unintended pregnancy. This review identified and evaluated concordance and quality of clinical treatment guidelines related to the use of HCAs in women with epilepsy (WWE) receiving EIAEDs.
Relevant clinical guidelines were identified across four databases and were independently evaluated for quality utilizing the AGREE-II protocol instrument. Quality in this context is defined as the rigor and transparency of the methodologies used to develop the guideline. Guidelines were further assessed in terms of concordance and discordance with the latest body of knowledge concerning the use of hormonal contraception in the presence of EIAEDs.
A total of n = 5 guidelines were retrieved and evaluated. Overall guideline scores ranged from 17% to 92%, while individual domain scores ranged from 0% to 100%. Contraceptive guidelines consistently recommended the use of intrauterine systems and long-acting injectables in the presence of EIAEDs, recommended against the use of oral, transdermal, and vaginal ring contraceptives, and differed regarding recommendations related to implants. Guidelines agreed regarding recommendations that women treated with EIAEDs should receive intrauterine systems and long-acting injectables; however, the suggested frequency of administration of injectable contraceptives differed. The use of intrauterine systems in this population is supported by evidence, but there is uncertainty surrounding the use of long-acting injectables and contraceptive implants.
To mitigate the risk of unintended pregnancy and its consequences, recommendations related to implants and long-acting injectable contraceptives should be evidence-based.
同时使用激素避孕药（HCAs）和酶诱导抗癫痫药物（EIAEDs）可能导致避孕失败和意外怀孕。本研究旨在确定和评估与接受 EIAEDs 的癫痫女性（WWE）使用 HCA 相关的临床治疗指南的一致性和质量。
在四个数据库中确定了相关的临床指南，并使用 AGREE-II 协议工具独立评估了这些指南的质量。在这种情况下，质量定义为用于制定指南的方法的严谨性和透明度。还根据激素避孕在存在 EIAEDs 时使用的最新知识，评估了指南的一致性和差异性。
共检索到并评估了 5 项指南。总体指南评分范围从 17%到 92%，而个别领域评分范围从 0%到 100%。避孕指南一致建议在存在 EIAEDs 的情况下使用宫内节育器和长效注射剂，反对使用口服、透皮和阴道环避孕药，并对与植入物相关的建议存在差异。指南一致建议接受 EIAED 治疗的女性应使用宫内节育器和长效注射剂；然而，注射避孕药的建议给药频率不同。在该人群中使用宫内节育器有证据支持，但长效注射剂和避孕植入物的使用存在不确定性。
为了降低意外怀孕及其后果的风险，应根据证据制定与植入物和长效注射避孕药相关的建议。
